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GI > Pathology: Oesophagus & Mouth > Flashcards

Pathology: Oesophagus & Mouth Flashcards

1
Q

What is the GOJ line?

A

Gastro-oesophageal junction

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2
Q

What does the Z line represent?

A

Squamo-columnar junction

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3
Q

What are causes of acute oesophagitis and how common is it?

A
  • corrosive due to chemical ingestion
  • infective in immunocompromised (e.g.candidiasis, herpes, CMV)
  • rare
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4
Q

What is CMV?

A

Cytomegalovirus (in herpes family)

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5
Q

What are causes of chronic oesophagitis and how common is it?

A
  • reflux oesophagitis
  • rare is Crohn’s disease
  • common
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6
Q

What is reflux oesophagitis?

A

Inflammation of the oesophagus due to refluxed low pH gastric content

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7
Q

What can cause oesophagitis?

A
  • defective sphincter function +/- hiatus hernia
  • raised intra-abdominal pressure e.g. pregnancy
  • abnormal oesophageal motility
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8
Q

What is a hiatus hernia?

A

Hiatus (opening where oesophagus goes through diaphragm) is larger than normal and part of stomach slips through

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9
Q

How does reflux oesophagitis appear macroscopically?

A
  • red, inflammed oesophagus

- black/purpley oesophagus

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10
Q

How does reflux oesophagitis appear microscopically?

A
  • basal zone epithelial expansion due to increased cell division due to increased cell desquamation (shedding)
  • intraepithelial neutrophils, lymphocytes and eosinophils
  • elongation of connective tissue papillae
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11
Q

What is Barrett’s Oesophagus?

A

Replacement of stratified squamous epithelium by columnar epithelium

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12
Q

What are complications of reflux oesophagitis?

A
  • stricture (narrowing)
  • ulceration (bleeding)
  • Barrett’s Oesophagus
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13
Q

What causes metaplasia of cells in Barrett’s oesophagus?

A

Persistent reflux of acid/bile

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14
Q

What may the columnar cells come from?

A
  • Expansion of columnar epithelium from gastric glands or from submucosal glands
  • From oesophageal stem cells
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15
Q

Why do columnar cells replace squamous in Barrett’s Oesophagus?

A

They regenerate faster and as a protective response

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16
Q

What is a macroscopic sign of Barrett’s Oesophagus?

A

Red velvety mucosa in lower oesophagus

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17
Q

What is a microscopic sign of Barrett’s Oesophagus?

A

Columnar lined mucosa with intestinal metaplasia

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18
Q

What are two results of Barrett’s Oesophagus?

A
  • unstable mucosa (continuing damage)

- increased risk of developing dysplasia and carcinoma of the oesophagus (intestinal metaplasia)

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19
Q

What is another name for allergic oesophagitis?

A

Eosinophillic oesophagitis

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20
Q

What factors is (age group, sex, medical history, family history) is allergic oesophagitis usually associated with?

A
  • young
  • males more than females
  • history of asthma
  • family history of allergy
21
Q

What are two clinical findings of allergic oesophagitis?

A
  • raised eosinophils in blood

- pH probe negative for reflux

22
Q

How does allergic oesophagitis present in endoscopy (macroscopically)?

A

Corrugated (feline) or spotty oesophagus

23
Q

How does allergic oesophagitis present microscopically?

A

Large number of intraepithelial eosinophils

24
Q

What are possible treatments for allergic oesophagitis?

A
  • steroids
  • monteleukast
  • chromoglycate
25
Q

What are the features of benign oesophageal tumours?

A
  • squamous papilloma
  • rare
  • papillary
  • HPV related
  • asymptomatic
26
Q

What are some very rare causes of benign oesophageal tumours?

A
  • leiomyomas
  • lipomas
  • fibrovascular polyps
  • granular cell tumours
27
Q

From what cells do Leiomyomas grow?

A

Smooth muscle cells

28
Q

From what cells do lipomas grow?

A

Fat cells

29
Q

From what cells are granular cell tumours thought to grow?

A

Schwann cells

30
Q

What are the two types of malignant oesophageal tumours?

A
  • squamous cell carcinoma

- adenocarcinoma

31
Q

What 6 potential causes of squamous cell carcinoma?

A
  1. smoking/alcohol
  2. Vitamin A, Zinc deficiency
  3. HPV
  4. Tannic acid/strong tea
  5. Oesophagitis
  6. Genetic
32
Q

What malignant oesophageal tumour is associated with Barrett’s Oesophagus?

A

Adenocarcinoma

33
Q

What can patient with squamous cell carcinoma in the oesophagus present with?

A

Dysphagia

34
Q

What are the 3 steps in the pathogenesis of squamous cell carcinoma?

A

Normal -> GORD -> severe dysplasia

35
Q

What factors (sex, weight, ethnicity, where in oesophagus) are related to higher risk of adenocarcinoma?

A
  • males
  • obese
  • caucasian
  • lower 1/3
36
Q

What are the 6 steps in the pathogenesis of adenocarcinoma?

A

genetic factors, reflux disease -> chronic reflux oesophagitis -> Barrett’s Oesophagus (intestinal metaplasia) -> Low-grade dysplasia -> High-grade dysplasia -> adenocarcinoma

37
Q

What are the mechanisms of metastases of oesophageal carcinomas and examples of where?

A
  • direct invasion e.g. local invasion
  • lymphatic permeation e.g. nodal metastases
  • vascular invasion e.g. to liver
38
Q

How might oesophageal carcinoma present clinically?

A
  • dysphagia

- general malignancy symptoms e.g. weight loss, fatigue, anaemia (due to metastases)

39
Q

What is a Mallory Weiss tear?

A

A tear in the mucous membrane often at the gastro-oesophageal junction often caused by excessive coughing/vomiting. Can cause severe GI bleeding.

40
Q

What are oesophageal varices?

A

Enlarged blood vessels in oesophagus often due to obstructed blood flow through portal vein

41
Q

What are most oral carcinomas?

A

Squamous cell carcinomas

42
Q

How can oral carcinomas present?

A

red, white, speckled, lump, ulcer

43
Q

What are the high risk sites of developing oral carcinomas?

A
  • lateral borders and ventral tongue
  • soft palate
  • retromolar pad
  • tonsillar pillar
  • floor of mouth
44
Q

What are some potential causes of oral carcinoma?

A
  • smoking
  • alcohol
  • betel quid (tobacco and betel nut chew)
  • patient with primary oral SCC at risk of developing secondary oral SCC
  • post transplant
  • potentially HPV
  • potentially chronic infections
45
Q

What are two variants of oral carcinoma histopathology?

A

verrucous(warty lesions) and acantholytic (loss of intracellular connections e.g. desmosomes)

46
Q

How are oral carcinomas graded?

A
  • TNM system

- factors e.g. degree of differentiation, depth and pattern of invasion, lymphovascular invasion etc.

47
Q

What does TNM stand for?

A
  • T -> greatest diameter of tumour, structures invaded
  • N -> lymph node status
  • M -> metastasis
48
Q

What is survival rates of oral carcinoma?

A

5yr 40% -50%

49
Q

What is treatment for oral carcinoma?

A

surgery +/- adjuvant therapy

GI (29 decks)

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